Provider Demographics
NPI:1306888219
Name:CODIGA, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:CODIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N MALL DR STE I102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7322
Mailing Address - Country:US
Mailing Address - Phone:435-628-3651
Mailing Address - Fax:435-674-7112
Practice Address - Street 1:321 N MALL DR STE I102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7322
Practice Address - Country:US
Practice Address - Phone:435-628-3651
Practice Address - Fax:435-674-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT471563147207R00000X
CAAFE66682207R00000X
UT5758941-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine